J Korean Acad Prosthodont.  2019 Jan;57(1):57-65. 10.4047/jkap.2019.57.1.57.

Full mouth rehabilitation utilizing computer guided implant surgery and CAD/CAM

• Kim S
• Han JS
• Kim SH
• Yoon HI
• Yeo IS

• KMID: 2432003
• DOI: http://doi.org/10.4047/jkap.2019.57.1.57

Abstract

Computer aided design and manufacturing and implant surgery using a guide template improve restoration-driven implant treatment procedures. This case utilized those digital technologies to make definitive prostheses for a patient. According to the work flow of digital dentistry, cone beam computed tomography established the treatment plan, which was followed to make the guide template for implant placement. The template guided the implants to be installed as planned. The customized abutments and surveyed fixed restorations were digitally designed and made. The metal framework of the removable partial denture was cast from resin pattern using an additive manufacturing technique, and the artificial resin teeth were replaced with the zirconia onlays for occlusal stability. These full mouth rehabilitation procedures provided functionally and aesthetically satisfactory results for the patient.

Keyword

Digital removable partial denture; Digital dentistry; Implant; Computer-aided design/computer-aided manufacturing (CAD/CAM); Computer guided implant surgery

MeSH Terms

Computer-Aided Design
Cone-Beam Computed Tomography
Dentistry
Denture, Partial, Removable
Humans
Inlays
Mouth Rehabilitation*
Mouth*
Prostheses and Implants
Tooth
Workflow

Figure

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  Fig. 1 Pre-operative intraoral view (A – E) and panoramic X-ray (F). (A) Occlusal view of maxilla, (B) Lateral view (right side), (C) Frontal view, (D) Lateral view (left side), (E) Occlusal view of mandible, (F) Alveolar bone loss around mandibular premolar teeth and left maxillary residual ridge can be observed in panoramic X-ray.

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  Fig. 2 Radiographic stent (A, D), plan of implant surgery (B, E) and surgical stent (C, F). (A) Maxillary radiographic stent (B) Four implants were planned on maxillary anterior (C) Maxillary surgical stent (D) Mandibular radiographic stent (E) Eight implants were planned on mandible (F) Mandibular surgical stent.

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  Fig. 3 Mandibular implant surgery with surgical stent. (A) Three anchor pins help adaptation of surgical stent (black arrows), (B) Drilling without flap elevation, (C) Total 8 implants were installed and healing abutments were inserted.

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  Fig. 4 Maxillary 1st implant surgery with surgical stent (A – C) and 2nd surgery (D – E). (A) Four implants were placed through surgical stent after flap elevation, (B) Bone graft with xenograft using Bio-Oss, (C) The bone particles were covered with collagen membrane, (D) The volume of ridge was well preserved 5 months after surgery, (E) Well-formed bone and stable implants were observed. (F) Healing abutments applied and sutured with palazzi's flap.

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  Fig. 5 Intraoral scan of mandible. (A) Scan bodies were applied, (B) Bite registration with scan body, (C) Temp cylinder and pattern resin, (D) Custom abutments were designed from scanned implants and jaw relation.

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  Fig. 6 Custom abutments of maxilla. (A) Custom abutment of maxillary implants using scanned master model, (B) Titanium linked zirconia abutments were placed in maxilla.

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  Fig. 7 Definitive prosthesis design procedure. (A) Each separate die was scanned separately, (B) Scanned separate dies and second die were overlapped and minimum thickness of monolithic zirconia prosthesis was determined (red color), (C) Full contour wax-up was overlapped with double scan technique, (D) Definitive monolithic zirconia prostheses were designed.

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  Fig. 8 Implant supported definitive prosthesis. (A) Frontal view, (B) Occlusal view of maxilla. Eccentric and protrusive movements were marked with black and green, respectively, (C) Occlusal view of mandible.

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  Fig. 9 CAD/CAM RPD design procedures. (A) Master model was surveyed, (B) Block out was carried out automatic with respect to selected insertion path, (C) RPD framework was designed, (D) 3D printed resin block was fitted in master model, (E) Fabricated metal framework was fitted in master model.

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  Fig. 10 Post-operative intraoral clinical photos (A–E), T-scan diagram (F), extra-oral photos (G and H) and post-operative X-ray (I). (A) Lateral view (right side), (B) Occlusal view of maxilla, (C) Lateral view (left side), (D) Frontal view, (E) Occlusal view of mandible, (F) Harmonized occlusion was established with T-scan (G) pre-operative extra-oral photos (H) post-operative appearance was also enhanced. (I) Post-operative panoramic X-ray shows stable implants and bone levels.

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